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The importance of impermeant support in small bowel preservation: a morphologic, metabolic and functional study
1Surgical-Medical Research Institute, University of Alberta, Edmonton, Canada.
Background:
Ambiguity exists as to which preservation solution is the most effective for small bowel (SB); studies have shown equivalent results with normal saline and University of Wisconsin (UW) solution. This study was designed to investigate the requirement of SB for oncotic and osmotic support, thereby reassessing one of the key principles of static organ storage.
Methods:
Rodent SB was vascularly flushed with the following solutions: group 1, 0.9% saline (154 mM NaCl); group 2, 154 mM NaCl +5% dextran; group 3, 104 mM NaCl +100 mM lactobionate + 5% dextran; and group 4, UW solution. Analysis of cellular energetics, permeability and histology (by electron microscopy) was performed over a 10-h time course of cold storage.
Results:
The addition of dextran and lactobionate to a simple saline solution (group 3) resulted in superior maintenance of several key parameters of energy metabolism throughout prolonged storage. At all times, ATP/ADP and EC ratios in group 3 remained unchanged from those of freshly isolated tissue; storage in normal saline and UW solution resulted in a progressive decline between 1 and 10 h of storage. ATP was also notably greater in group 3 than in group 1 or UW after 10 h of storage. Functional parameters demonstrated significant improvements in maintaining barrier function and membrane ion/electrical activity in group 3. Of particular note, after 10 h of storage, permeability for groups 1, 3 and UW was 215, 76 and 400 nmol/cm2/h, respectively, compared with a fresh tissue value of 22 nmol/cm2/h. Scanning electron micrographs revealed complete epithelial denudation of bowel stored in simple saline and UW solutions at 10 h. The incorporation of 100 mM lactobionate plus 5% dextran in group 3 prevented extensive villus denudation; the presence of intact microvilli indicated normal epithelial cell morphology.
Conclusion:
The order of solution effectiveness was group 3 > group 2 > group 1 > group 4. Vascular supplied impermeants, when supplied in simple solution, provide markedly improved preservation of metabolism, barrier function, and morphology of SB compared with UW.